ADVICE TO THE NEW ONTARIO MINISTER AND DEPUTY MINISTER OF HEALTH

Most people in the health sector breathed a sigh of relief when Ontario voters rejected the Tories — and with them, several seriously ill-conceived policies on the healthcare sector.

However, as I and others have consistently pointed out, it did not matter who won the provincial election, because, whoever formed the government would be faced with what is: a truly unsustainable system for delivering healthcare services.

While nobody in the provincial government today ever talks about “the discipline of the marketplace“, trust me. It’s coming. Ontario is in big trouble, and we are about to pay through the nose for it over the next three or four years.

Credit rating agencies analyze the ratio of provincial debt to revenue to gage each province’s capacity for managing debt — just as a bank examines our ability to pay the mortgage on our homes. What the government will be hearing these days isn’t good news.

Moody’s Investor Services says that Ontario has by far the highest ratio of any province — where our debt now amounts to 238% of our revenue. As a result, they just adjusted our status from “stable” to “negative”. That means the cost of borrowing money is going to increase for Ontario’s taxpayers.

A credit rating drop predicted to come within weeks — combined with a 1% hike in interest rates — can easily cost Ontario taxpayers another $4 or $5 billion in additional interest charges — on top of the $10.6 billion in interest payments we’re already paying today.

The new Ontario budget — which the people of Ontario voted for in the election — adds billions more to our existing $300 billion debt. However, the government has promised to reduce the deficit by at least $4 billion a year — for the next three years. People are asking: if 55% of our provincial expenditures are on wages, who is going to contribute to the $12 billion in “required savings” over the next three years? Whose ox will get gored?

Since it is estimated that up to 30% of our $50 billion healthcare expenditures are wasted, the healthcare budget will no doubt be under pressure — certainly in next year’s provincial budget.

Addressing these financial realities for our healthcare system, will require our provincial leaders to demonstrate unprecedented vision and courage. People truly want our leaders to succeed in transforming our healthcare system to be more customer-focused — with higher quality, and more effectiveness.

The people of Ontario did make a choice in the election: they want their government to be “force for good in their lives”. They are counting on our leaders to “fix” our healthcare service delivery system — including getting rid of waste, and reallocating resources to where they are needed.

But will Kathleen Wynne, Eric Hoskins and Bob Bell be visionary and courageous enough to cause those types of transformational changes over the next two, three and four years? Will they in fact lead our healthcare system through a fundamental transformation from caterpillar to butterfly — or, will they simply continue with the same/old tired health reform rhetoric that certainly seemed sincere out of the mouths of the last three Ministers — but never really materialized?

Where is all the “health reform” we already paid for? The numerous examples of real innovation that I have seen came from local leadership and front-line wisdom — not from a costly government program. These issues will be the focus of my future blogs — as our new leaders hopefully seize control of the agenda.

I expect that Minister Hoskins will produce high-level strategic directions for the healthcare service delivery sector within the next six months — perhaps by next January.

In the meantime, I think our new Minister will be listening very carefully to what the various self-interest groups and patients’ groups within our healthcare service delivery system have to tell him about creating a better, more effective healthcare delivery system — for less money. As a passionate reformer and advocate for the little guy and the weak, he will also be “open to new ideas” from groups that have not traditionally had easy access to the Health Ministry’s inner circle of power and influence.

With the “Changing of the Guard” at Queen’s Park comes the possibility that old paradigms and ways of thinking will end. A new Premier, Minister and Deputy certainly generates hope for a fundamental mindset and cultural transformation. While “Changing the Guard” at Buckingham Palace is a very precise and disciplined process, at Queen’s Park, we encounter a very messy, complex, adaptive human system of interrelationships that are driven primarily by power, money, status and ego.

Changing all of the key power players at once creates a highly threatening environment to the status quo — and to those who thrived in the former regime and benefited from the lack of transparency.

However, the countervailing force against the existing status quo is Kathleen Wynne — with a very different grassroots perspective than her predecessor — who loved the high-tech and “big IQ” projects; Eric Hoskins, a social justice Rhodes Scholar, who, as a passionate reform-oriented policy-wonk, has now been handed an historic opportunity to actually save medicare from collapse; and, the Minister’s key-person, Bob Bell, a self-described “healthcare rink-rat”, who, as Deputy, will oversee the implementation of the new government’s evolving policies for improving mental health services, reforming the primary care service delivery system, and finally getting in the illness prevention business.

This is the group that will be accountable for successfully transforming healthcare within the next four years. But will they succeed? Will this new leadership group actually “think-outside-the-box”? Will they reach beyond the same old tactics, to generate the actual transformation of the delivery system at the local level?

How will our new leaders — with their fresh perspectives — respond to the initial round of briefings that they will get at the same/old, same/old MOHLTC, and from the same/old vested interest groups?

In addition to the “inner circle” of interconnected friends, the formal Government Structure of the MOHLTC will also be experiencing high-levels of anxiety. Will they be able to survive the leadership shift? Will they win the new guys over? There’s lots at stake! Jobs. Money. Power.

Over the past decade, MOHLTC was able to grow and thrive as they responded to the opportunities provided by numerous scandals to expand their “control” over the healthcare service delivery system from their Bay Street offices in downtown Toronto. Despite the government’s own legislation to create LHINs, and downsize the MOHLTC, the number of Assistant Deputy Ministers in fact grew over their first two terms from 5 to 14 — each with multiple new branches seeking even more things to “control”, and more people to “command”.

The assumption in our current health system design is that we need a centralized bureaucracy to provide the operating system with templates/processes/regulations that require extensive monitoring to ensure compliance with what Queen’s Park says. However, will Hoskins/Bell /Wynne stick with that assumption — that our delivery system needs to be micro-managed from Queen’s Park? Does the new team believe that because Queen’s Park puts forward the “illusion of control”, that they actually have any control?

It would be prudent for the new leadership to remember that the MOHLTC is itself a narrow self-interest group that does not always operate in the public interest. While the initial briefings for the new leadership team will no doubt feature a predominant underlying theme of the compelling need to “protect the status quo”; and, to maybe consider some additional “minor tinkering” that essentially leaves MOHLTC intact — in control — and continue to be unaccountable for the system chaos they create.

Nevertheless, the pressure for fundamental transformational change will be significant — and time will be of the essence.

The Wynne/Hoskins/BellTeam cannot afford to wander about for the next two years contemplating, “what we should do differently?” If they are going to demonstrate progress by the next election — four years from now — they need to start sooner than later. They need to set out high-level strategic directions within five or six months — perhaps by next January/February, 2015.

Along with their policies and priorities, they need an interlocking set of mission statements that clarifies everyone’s roles over the next four years: the role of the MOHLTC; of the LHINs, of governing boards and CEOs, and the roles of the Health Service Providers.

People who want to see changes in roles/authority/mandates, need to communicate their best thinking to the Minister now.

Some groups will understand and really “get” that this next six months provides a time-limited opportunity to think creatively about how our public services ought to be re-invented.

Formal Vested Interest Groups — including the OMA, OHA, RNAO, AOHC, OACCAC, etc — will be up-dating and re-aligning their self-interests with what they perceive the new power players want to hear. The more reform-oriented interest groups like Patients Canada, Association of Ontario Health Centres, RNAO, Canadian Mental Health Association, the Ontario Community Support Association and several others, could be welcomed into the evolving “inner circle” of influencers as the generational leadership evolves and transforms in partnerships with the new leadership team.

The more traditional lobby groups will also be tarting up their most recent policy papers, advocacy positions, and, in some cases, their “vision” for how Ontario’s healthcare system should be organized and managed. This, I think, will be time well-spent. These high-level strategies will almost certainly capture the attention of a scholarly policy-wonk like Eric Hoskins.

Policy Papers — like the ones created just before the election by RNAO, and by the OACCAC — are focused on the “big picture” — with an emphasis on how the system could be changed and improved. Hoskins has to address the big questions these groups raise.

Joining the debate about the design of our future system will be another powerful self-interest group that will be anxious to maintain the status quo: the CEOs of the Health Science Centres — who could potentially be faced with steep spending cuts over the next four years with a Premier and Minister who are strongly oriented to shifting to community care, primary care, mental health services, health promotion and chronic disease management.

Some Health Science Centres have already undertaken the exercise: how would they downsize by 5% if they had to? Some are exploring how to make money from “medical tourism”, and other revenue-generating ideas.

While there has been some negative gossip over the early summer about how our new Deputy, Dr. Bob Bell, may be limited by a rigid “University Ave Lens/Perspective“, paradoxically, our new Deputy could in fact become a countervailing force — as he grapples with his role of implementing the government’s priorities on: primary care reform, mental health service expansion, health promotion/illness prevention — and, improving the patient’s experience across the delivery system.

We don’t know where our Deputy is heading yet, but he clearly signed-on for “big changes” in our delivery system. The key issue of devolution may rest on the final report of the Standing Committee Of The Legislature that conducted hearings across Ontario to learn about what the system believes needs to happen with LHINs, CCACs and HSPs.

It will be interesting to learn about their insight on how the government could improve on this initial attempt at local empowerment through the Local Health Integration Networks. What will they recommend?

Our most recent Leadership Survey @ TedBall.com found that 76% of health system leaders believe in some devolution/local empowerment — but with many calling for the transformation and re-skilling of the LHINs. But will the status quo still win?

If the choice is between saving our healthcare system through local empowerment, and downsizing the Ministry of Health, it will also be interesting to see where our public sector unions stand on that question. Former Health Minister Deb Matthews will be drawn into this debate about “Saving Medicare” vs. “Saving MOHLTC” in her key role on spending controls and dealing with the public sector unions.

Remember 19 unions spent $9 million in the final week of the campaign on ads saying: “Don’t vote for Hudak“. How will the government respond to their election allies? Or, will they actually opt for real health system reform, and topple the Ministry in favor of local empowerment — while being fair and generous to its employees?

There will be no end of complex and messy challenges for the new leadership team. The issue will be their preparedness to actually step away from the status quo, and the same/old same/old solutions and “fixes-that-fail” in order for them to take focused leveraged actions that will propel our health services delivery system into transformation, as we shift from caterpillars to butterflies. Real transformation, not rhetoric.

While consumer empowerment is the ultimate goal, our leaders need to start empowerment earlier in the food chain — by empowering the LHINs to liberate HSPs, and by Health Links to implementing their local health system improvement agendas, while HSPs empower their front-line healthcare service providers to re-design the patient experience in their silos.

It will be interesting to see what LHINs do in response to the arrival of the new Minister.

The LHINs could potentially become the new Minister’s “eyes & ears” on the delivery system — like their DHC predecessors. They could also be the Deputy’s “window on the delivery system”. However, the LHINs have historically been strongly influenced by the MOHLTC staff, rather than having strong relationships with the Minister’s Office. Will Hoskins embrace LHINs as his “agents” in local communities?

Since their establishment, the LHINs have mostly been silent on the “devolution” issue — as three Ministers, two Deputies and four ADMs ignored the legislation empowering the MOHLTC to devolve spending authority from Queen’s Park to local communities. The idea was to “empower the LHINs” to fund their own Integrated Health Service Plan for their community. Some LHIN leaders have spoken up, but most have been silent.

So the question is: will there be a serious effort to transform, re-invent and re-skill our public services, or, are we going to continue on our long slide from a healthcare system that ranked third place in the world just ten years ago, to having now slipped to 11th place — behind the US, and behind most major developed countries?

Pulling us out of this rut and leading strategy implementation bureaucratically will be the new deputy Minister and his three Associate Deputies — Susan Fitzpatrick,Helen Angus and David Hallett — with Fitzpatrick basically operating as the COO of the Ministry.

Will this MOHLTC Executive Team become “out-of-the-box thinkers”, or are we up for more of the “same/old, same/old”? Most people seem optimistic, but time will tell.

While Dr.Eric Hoskins is still an unknown quality, the fact is that the very survival of Medicare in this province, and in this country, is now in his hands. He didn’t ask for this job, let’s hope he, his Deputy and the Executive Team at MOHLTC do well.

I don’t know anybody who doesn’t truly wish our new leaders the very best. We need them to be successful. When they succeed, we all succeed. We each need to ask: how can we help the Minister and Deputy be successful? We also need to hold them accountable for the results they produce. They are in stewardship to the system.

Within the next 100 days — to six months — we will learn whether Mr. Hoskins and his aligned team will embrace the status quo/the inner circle/and the same/old namby-pamby empty rhetoric about health reform, or, if indeed — as I predict — our new reform-oriented Minister will actually lead the fundamental paradigm shift required to re-invent and transform how our existing health and health-related social services are delivered — perhaps just-in-time for the next election, perhaps even with Dr. Hoskins heading to the polls as leader of his party in 2018.

There are a number of successful Health Ministers who have sought their party’s leadership — several successfully. They say: “Here is what I accomplished in healthcare, imagine what I could do as Premier.”

So Hoskins, and the staff he puts in place, will indeed be open to new ideas — and to new ways of seeing old problems. They have the very important task of “saving medicare and transforming healthcare” ahead of them.

Nevertheless, for the most part, over the next few months our new leaders will be encouraged at numerous briefings to maintain as much of status quo as possible — with only some “minor tweaks”. So how would YOU advise the new Minister? Here is your chance to join with perhaps a hundred or more other leaders to communicate your best advice — anonymously.

Health Leaders’ Surveys @ TedBall.com have provided the 1,500 to 2,500 readers who reviewed them each time with important insights from the 150-200 leaders who invest 10 minutes to provide anonymous briefings to Minister/Deputies/decision-makers/health system leaders.

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What Patients Want

We can help with

Patient Experience Design Methodologies

Read about Experience Design Storyboard And Master Process. These truly innovative and effective methodologies are very exciting because they transform the customer/patient /client experience – while significantly improving efficiency and creating more satisfied and engaged healthcare service providers.

Drug Savings

Read a great paper by the extraordinary public servant, Helen Stevenson, who saved $1.5 billion in ODB costs.

Getting To Integration: Command & Control/Emergent Process

Are mergers of small organizations really going to improve our healthcare system? Read this paper in the Public Sector Innovation Journal by Steve Lurie, CMHA, Toronto.

World-Class Resource

"Ted is a world-class resource for providing insight and intelligence to understanding and solving complex challenges. He regularly can recall a myriad relevant ideas and experiences that can be either practical or thought-provoking. If there was something important but impossible to do he is the first one I'd call."-- Art Frohwerk, Managing Partner at Clearpath, LLC

Honestly & Integrity

"Ted Ball is a brilliant system thinker, and the best intelligence gathering resource Ontario has. But, what is uniquely exquisite about Ted, is his no non-sense attitude, honesty and integrity to share information generously and widely. Working with Ted is at once - inspiring, stimulating and fun! "

Second curve leaders

Download Designing and Creating Second Curve Healthcare System to discover more about our evolving health system. As you read through what the system will be like over the next three to five years, what do you think are the skills and capabilities required by 2nd Curve Leaders.

Conference Speaker/Retreat Facilitator

Ted Ball is available to address conferences or design retreats for Governance & Management. Give him a call @ 416-581-8814 and explore your unique circumstances.

Warning

Seventy percent of all major change projects fail. While 30% succeed, Quantum’s curriculum reflects the “lessons learned” from the 15% who experience dramatic performance improvements.

This Stuff Works!

“After our two-year investment in capacity-building with Quantum, we had remarkable performance improvements and extraordinary value. Today, our 120 directors, managers and other key leaders are not just more strategic, more aligned and more leveraged, they are also happier, more collegial and more effective as leaders and managers. We are achieving real results with these adult learning technologies and systems thinking tools.”

Bonnie Adamson
Former CEO, North York General Hospital, 2008

Leadership Development

TED BALL has been a coach, guide and mentor to CEOs, Ministers of Health and Executive Directors of community agencies for 20 years. Now, through the Quantum Leadership Institute, you can access Ted’s leadership coaching insights as well as the powerful learning tools from Quantum to prepare you as a 2nd Curve health system leader. Following an assessment and evaluation dialogue with Ted Ball, coachees can either co-design a leadership learning journey to match their unique needs and budget, or determine that other types of investments in their learning & growth would be more appropriate for their goals.

Releasing Human Capacity

“I was so inspired by the coaching model Ted used, I decided to work on a PhD and learn more about human potential and how to release it.”

The Patient Voice Poised To Become The Dominant Driver

Today’s healthcare providers were not trained to provide PCC. They lack the requisite skills, and patient empowerment unsettles them.

The term PCC does not accurately describe what modern patients seek. Patients do not want to be at “the centre” of a healthcare construct; they want to be recognized as full partners in their care, and are speaking about this with an increasingly unified and powerful voice.

Indeed, while economics, demographs, and technological advances will continue to prompt change ‘the patient voice’ is poised to become its dominant driver.”

Learn how to deal more effectively with the Provincial Government. Darwin Kealey & Leonard Domino have advise here: Leonard Domino

We can help with

Measuring What Matters

“There is a clear misalignment between what Canadians value, and how Canadian health system performance is measured and funded. Canadian values have shifted substantially in recent years, towards a preference for greater autonomy and empowerment in managing their health care and management. Canadians' values reflect the desire for a more ‘personalized’ health care system, one that engages every individual patient in a collaborative partnership with health providers, to make decisions that support health, wellness, and quality of life.”
Click here for the executive summary of Measuring What Matters: The Cost vs. Values of Health Care – a must read white paper from the Ivey Centre for Health Innovation.

Heart In Healthcare

Become part of the worldwide movement to re-humanize healthcare. Heart In Healthcare aims to:

• To encourage health workers to reconnect to the heart of their practice
• Allow compassionate caring to rise above institutional rules and limitations
• Create the world’s most inspiring community of health professionals, students, patient advocates and leaders, working together in a worldwide movement to transform healthcare from within.

Big Changes Ahead For Health “System”

Changing Structures Too Expensive/Disruptive

"In Ontario unless there is a compelling political and financial case made to restructure the system, it’s safe to assume that Ontario will not move to formalize health system integration through disbanding organizations and creating regional health authorities. The evidence is overwhelming that not only would it be an extremely expensive proposition – somewhere in the $4-5 billion range to harmonize wages – but it would also be extremely disruptive – taking some 4-5 years to re-establish some form of equilibrium – and could also have a significant negative impact on foundation fundraising on which hospitals in particular are dependent."

Saskatchewan Health Plan Five-Year Outcomes

• There will be a 50% improvement in the number of people surveyed who say, “I can contact my primary healthcare team on my day of choice”.
• There will be a 50% reduction in the age-standardized hospitalization rate for ambulatory care sensitive conditions.
• (by March 31, 2014) All patients have the option to receive necessary surgery within three months.
• Zero surgical infections from clean surgeries.
• No adverse events related to medication errors.
• The healthcare budget increase is less than the increase to provincial revenue growth.
• The healthcare budget is strategically invested in information technology, equipment and facility renewal.
• Zero work place injuries.
• (by March 31, 2022) there will be a 5% decrease in the rate of obese children and youth.
• There will be a 50% reduction in the incidence of communicable disease.
• Seniors will have access to supports that will allow them to age within their own home and progress into other care options as their needs change.
• Patients’ ratings of exceptional overall healthcare experience are in the top 20% of scores internationally.
• There will be a 50% reduction in patient waits from General Practitioner referral to specialist and diagnostic services.
• (by March 31, 2015) all cancer surgeries or treatments are done within the consensus-based timeframes from the time of suspicion or diagnosis of cancer.
• Individuals with severe complex mental health issues with alcohol co-morbidity or acquired brain injury will have access to supportive housing in or near their community.
• No patient will wait for emergency room care (patients seeking non-emergency care will have access to more appropriate care settings).
• Employee engagement provincial average score exceeds 80%.
• Increase physician engagement score by 50%.

Hospital leadership

“Over time, we'll need fewer and fewer hospitals. Boards of those institutions need to just remember that the scope of what they need to do is to be responsible for the health of people, not the preservation of the institutions."

—Clayton ChristiansenDisruptive Innovation

Leadership

“The most important lever for change is modeling the change process for other individuals. This requires that the people at the top engage in the deep change process themselves.”-- Robert E. Quinn
Deep Change

Real Devolution

“A regional health authority, if it’s going to be effective, should be able to determine how money is spent within a region, shifting money from hospitals to community care, from treatment programs to prevention, and so on. This approach worked extremely well in Alberta, so well that it was dismantled because it stripped too much power and control from politicians and policy-makers in the Health Ministry.”-- André Picard
The Globe and Mail

Warning

Seventy percent of all major change projects fail. While 30% succeed, Quantum’s curriculum reflects the “lessons learned” from the 15% who experience dramatic performance improvements.

The Patient-Centred Care Experience:

Like rainbows, examples of patient-centered care are few and far between, but here are some tell-tale signs:
• Providers and patients know each others’ names;
• Patients’ opinions are actively sought, listened to and honored where possible;
• Patients tell you that their doctors and other team members really listened to what they had to say;
• Patients are treated as the most important member of their health care team and taught how they can best contribute to the team’s success;
• Providers feel that their patients are actively involved in their own care; and,
• You see a significant improvement in patient health status, adherence, engagement, level of utilization and patient/provider experience.
-- Steve WilkinsMind the Gap

What is Patient-Centred Care?

Patient-centered care means involving patients in the planning, delivery and evaluation of health care where it really counts in terms of outcomes, patient adherence, cost reduction and fewer re-hospitalizations.
Being patient-centered is like doing a market research study and then implementing the findings. Patient-centered care does not give absolute control to patients, it simply invites them into the party and gives them a place at the table. As providers, we don’t do a good job of listening to patients. We do an even worse job when it comes to acting on what patients tell us they want.
-- Steve WilkinsMind the Gap

Guiding Principles For Patient-Centred Care

1. Care is based on continuous healing relationships.
2. Care is customized and reflects patient needs, values and choices.
3. Families and friends of the patient are considered an essential part of the care team.
4. Knowledge and information are freely shared between and among patients, care partners, physicians and other caregivers.
5. Patient safety is a visible priority.
6. The patient is the source of control for his or her care.
7. All team members are considered caregivers.
8. Care is provided in a healing environment of comfort, peace and support.
9. Transparency is the rule in the care of the patient.
10. All caregivers cooperate with one another through a common focus on the best interests and personal goals of the patient. (Borrowed from Margaret Gerteis et al.(Through the Patient’s Eyes)

Canada on Top:

Canada was in the top spot for the number of accidental punctures or lacerations during surgery out of the 17 countries surveyed by the Organization for Economic Co-operation & Development (OECD).

At 525 per 100,000 hospitalizations, its rate was more than three times as high as Britain (174) and the U.S. (166).

Patient Engagement:

“Almost half of Canadians with a regular doctor feel engaged in their healthcare. By engaged, we mean that patients always have enough time during visits, can always ask questions about recommended treatment, and are as involved as they want to be in decisions about their care.”

– Health Council of Canada Bulletin 5
September, 2011

Learning Organization

According to David Carnevale, author of Trustworthy Government, one of the key differences between learning organizations and traditional controlling organizations “is that deeply ingrained defensiveness so characteristic of low-trust, traditional bureaucratic organizations undermines necessary learning. Trust expedites learning.”
Carnevale says that “Healthy learning organizations are managed with the objective of liberating and using employee know-how to improve work processes. The emancipation of employee know-how is enabled through a different philosophy of organization and job design, communication patterns, labor-management relations, participatory methods, and other processes that reduce the climate of fear and allow staff the necessary psychological peace of mind to fully engage their work”.

Assumption of Competence

Traditional bureaucratic organizations are dominated by the need for control and conformity -- assuming that workers are incompetent, and therefore must be carefully managed. In turn, this creates high degrees of mistrust, defensiveness and fear -- all of which undermine learning.

In learning organizations, the assumption of competence is supported through the encouragement of curiosity, creativity and innovation. The people who deliver the organization’s services directly to its customers are encouraged to use their know-how to improve work processes. While successes are a cause for celebration, learning organizations must also accept and forgive mistakes as part of the learning process. They must be open to learning from their “best mistakes”.

Leadership/Adaptive

Adaptive leadership means raising tough questions rather than providing answers; it means framing the issues in a way that encourages people to think differently, rather than laying out a map of the future; it means co-creating with people their new roles, power relationships, and behaviors, rather than orienting them in a new direction and giving them a big push.

Shared Vision

At its simplest level, a shared vision is the answer to the question: “What do we want to create. A shared vision is the vision that people throughout an organization or a community of organizations carry about what we want to be in the future.
Peter Senge describes the concept of a Shared Vision in his book The Fifth Discipline. He writes, “a shared vision is not an idea. It is, rather, a force in people’s hearts, a force of impressive power. It may be inspired by an idea but once it goes further - if it is compelling enough to acquire the support of more than one person - then it is no longer an abstraction. It is palpable. People begin to see it as if it exists. Few, if any, forces in human affairs are as powerful as a shared vision.”

Shifting Gears Report:

“Devolve decision-making selectively and where appropriate. Policy makers should consider expanding the accountability functions of regional bodies, strengthening specialty care networks, and supporting organic mergers and acquisitions within the system. Any system transformation primarily focused on significant governance reforms—for example by reinventing regional bodies from scratch—could actually distract attention from the more organic reforms needed that will have a positive impact on fiscal sustainability and produce unnecessary delay in implementing transformative change.”
– University of Toronto

Health Care & Physicians Costs

“A healthy economy and shrinking government debt over the past decade seem to have been the main drivers for soaring health-care spending, while the much-feared aging of the population is having relatively little impact on medicare's bottom line, a new federal-provincial report concludes.
CIHI said that total health spending - by governments as well as private individuals and health plans - is set to reach $200-billion this year, about $5,800 per person. That is an increase of 4%, the smallest one in 15 years.
A separate report looked at the drivers of health spending between 1998 and 2008, when the figure rose by an average of 7.4% per year.
Spending on physicians is the fastest-growing chunk of the budget now, with the increase for 2011 projected to slow slightly to 5.6%. More doctors are being added to the system - 6,500 between 2005 and 2009 - while their income rose by an average of 3.6% per year. That followed a period from 1975 to 1998, however, when MD compensation rose more slowly than other public goods and services.”